Rehabilitation Care after Hip Fracture in Older Patients with Cognitive Impairment: Systematic Review

Abstract

Background: Hip fractures (HF) are frequent in older adults. A substantial number of cognitively impaired patients are admitted to rehabilitation units, where they will receive the same care program as non-impaired patients. The aims of this literature review are to describe the results of short, medium and long-term rehabilitation for cognitively impaired patients Methods: We conducted a systematic review of French and English articles of human studies in MEDLINE via PubMed with the key words “hip fracture“ AND “rehabilitation” AND “dementia. In a second step, the references of selected articles were analyzed and a complementary search on Google Scholar was conduct for an exhaustive literature search. We extracted data on the author name, the journal, year of publication, study design, total number of patients and number of cognitively impaired patients, mean patient age, time and modality of the cognitive assessment, inclusion and exclusion criteria, rehabilitation program, and primary endpoint. Results: The initial literature search retrieved 147 articles. 16 reports of studies representing 2,255 patients were selected. Our study reveals that multidisciplinary rehabilitation is possible and permits functional gain that persists in the long-term. The intensity of rehabilitation can be as high as for subjects without cognitive impairment. Characteristics of dementia are prognostic factors of rehabilitation (severity of dementia, profile of dementia). Other accessible factors are malnutrition, depression, family. Conclusion: Concerning patients with cognitive impairment, although our data do not permit establishing recommendations for rehabilitation after HF, some important elements emerged from this review. Additional studies are needed to better define rehabilitation programs adapted to the specificities of the different types of dementia.